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Mass murderers and SSRIs

I write this as the US is wallowing in another round of hand-wringing from another mass shooting. The carnage in Las Vegas featured a guy with a dozen or so probably legally obtained rifles raining bullets on the crowd attending an outdoor concert. His actions resulted in nearly 60 dead and 500 or so wounded. News reports say the police continue to probe the shooter’s motives. After all, don’t we all want to know the ‘why’ of what seems like a senseless act of violence? Maybe if we understood what happened, we could prevent such events in the future, right?

Yet as his motives are hypothesized, dissected and discussed, most of us just wonder if the guy was ‘crazy’ and what made him so. The killer’s background, his childhood, his links to terrorists organizations and his state of mental health will be extensively probed. But here’s one dominant theory that won’t get much airtime, but which has been circulating for at least two decades: maybe it’s the drugs.

Even before the 1999 horror of the Columbine High School shootings, theories about the effects of psychiatric drugs had been proffered. We know that one of the Columbine shooters, a boy named Eric Harris, was taking the SSRI Luvox. Psychiatrist Peter Breggin, author of Toxic Psychiatry and Talking Back to Prozac has written extensively about violence in association with taking SSRI antidepressants. He wrote that Eric Harris was probably suffering a “drug-induced manic reaction caused by Luvox,” adding, “The phenomenon of drug-induced manic reactions caused by antidepressants is so widely recognized that it is discussed several times in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.”

It could be that taking any number of psychiatric drugs may be like putting a match to a powder keg of an angst-ridden and suicidal person, who is heavily armed. We have long known that the most commonly-prescribed antidepressants – selective serotonin reuptake inhibitors (SSRIs) – sold as Prozac, Paxil, Effexor, Celexa, Luvox and Zoloft, can trigger impulses that lead to suicide or homicide. While these drugs are prescribed for depression and mood disorders, they have carried FDA black-box warnings since 2004 and are associated with “a risk of suicidal thinking, feeling and behaviour in young people.” Whether or not this association happens in adults has been roundly debated for years, yet there are other adverse effects related to SSRIs that can be equally deadly.

Akathisia – a reason for suicide?

All of the SSRIs can cause akathisia in some patients. Akathisia has been described as “subjective distress,” a state of unbearable discomfort where the person suffers extreme restlessness and agitation. It is an emotionally turbulent state that some say can lead to a sort of ‘out-of-body’ feeling. One expert witness in a lawsuit involving Zoloft described it this way: “It may be less of a question of patients experiencing [SSRI]-induced suicidal ideation than patients feeling that death is a welcome result when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders.” He went on to say that “akathisia has the potential, when it is severe, of contributing to suicidality and aggression.”

The numbers of people taking SSRIs in our society are huge, yet the rates of those who commit violent acts of rage are, thankfully, small. Or are they? It’s likely those data aren’t collected, but there seems to be growing evidence these drugs sometimes play a role in the commission of violent acts. The website SSRI Stories (www.ssristories.org) describes itself as containing “over 6,000 stories that have appeared in the media – newspapers, TV, scientific journals – in which prescription drugs were mentioned and in which the drugs may be linked to a variety of adverse outcomes including violence.”

Some might debate these ‘data,’ saying it is always ‘crazy’ or deranged people who commit these violent crimes. In fact, the lawyers defending the drug companies in hundreds of class action lawsuits almost always point out that, if people commit suicide or other acts of violence while on their drugs, it is because those people are severely depressed and that it’s not the fault of the drug. At the same time, it is well known that stopping, starting or altering doses of SSRI medications can cause terrible, adverse effects in some people.

One such incredibly heartbreaking story concerns a man in Ontario who suffered one of the rare, but more serious, adverse effects related to SSRIs: severe psychosis and delusions. In 2004, David Carmichael, suffering from psychosis, killed his 11-year-old son, Ian. He was taking the antidepressant Paxil at the time and was immediately charged with first degree murder. Later judged to be “not criminally responsible” for murdering Ian on account of a mental disorder and freed from jail, David Carmichael has a different take on what was actually going on. He carefully documents his story on the website http://www.davidcarmichael.com and has become a bit of a local champion in terms of publicizing the many scandals around the SSRI antidepressants.

Carmichael writes that, according to Andy Vickery, a trial lawyer from Houston, “Big chemical drug pharmaceutical companies argue in wrongful death claims involving SSRIs that suicides and/or homicides are triggered by the ‘disease’ (e.g., major depression), not the ‘drug.”

He adds, “The evidence that my lawyer collected immediately after I killed Ian contradicts this argument. My ‘psychosis’ was not triggered by my ‘major depression.’ Results from the psychometric tests indicate that I was not in a major depression at the time of the killing. It appears that Paxil shot me out of my depression into a severe psychotic state within three weeks of starting the drug and within two weeks of increasing my dosage from 40 to 60mg a day.”

This observation is backed up by a psychiatric assessment. In his PDF-available book entitled Killer Side Effects, Carmichael writes that a forensic psychiatrist at the Brockville Mental Health Centre told him that, while he was in a severe state of depression, it was Paxil that “likely triggered the psychotic episode that caused me to kill my 11-year-old son Ian on July 31, 2004, not my major depression.”

Prescripticide

David Carmichael is articulate in describing what he thinks killed his son and has coined a word to describe it: “prescripticide.” He writes, “Adverse reactions to SSRIs are causing people to commit suicide and homicide and, in fact, adverse reactions to prescription drugs are the 4th leading cause of death in Canada after cancer, heart disease and stroke.” He came up with a single word to explain what is happening: “prescripticide.” (See https://rxisk.org/three-weeks-to-prescripticide/)

Is “prescripticide” really a ‘thing’? Are widely used prescription drugs facilitating behaviour that may sometimes lead to murder? Maybe it’s best to look at what the manufacturers themselves are required to say: as of 2004, all labels for SSRI antidepressants are required to list the following adverse effects: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity and akathisia.

It might be too early to tell what drug the killer in Las Vegas was taking, if anything, but you can be sure there will be other mass killings and likely other mass murderers who were acting under the influence of an SSRI. People worry about the uncontrolled gun culture in the US, but perhaps most worrisome is that we’ve also got an uncontrolled population of millions of people taking psychiatric drugs as well and the two are a potentially toxic combination.

When David Carmichael says, “If I’m not criminally responsible for murdering Ian, maybe someone else is,” I think there is a whole range of possible suspects, many who, unfortunately, will still be getting away with murder.

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Alan Cassels is a writer and former drug policy researcher. His latest book isThe Cochrane Collaboration: Medicine’s Best Kept Secret. @AKECassels

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